Pharmacy Benefit Manager (PBM) Legislation Updates and Guidance

This section provides timely updates on state and federal legislation, Division of Insurance bulletins, and regulatory guidance relevant to pharmacy benefit managers (PBMs) operating in Colorado. Here, you'll find official interpretations, implementation timelines, filing instructions, and compliance resources to support your obligations under current law. PBMs are encouraged to check this page regularly to stay informed of key deadlines and policy changes that may impact contract terms, reporting requirements, and market conduct expectations.

HB25-1222 Preserving Access to Rural Independent Pharmacies

Guidance for House Bill 25-1222

October 7th, 2025

House Bill 25-1222, a piece of legislation designed to support the sustainability of rural independent pharmacies and ensure fair business practices from Pharmacy Benefit Managers (PBMs), has been signed into law.

The new law takes effect on January 1, 2026.

The legislation addresses critical challenges faced by community pharmacies in rural areas, which are often the sole source of prescription medications and health advice for their communities. A key provision establishes a fairer reimbursement model, requiring PBMs to reimburse rural independent pharmacies for prescription drugs at a rate no less than the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee.

Key provisions of HB 25-1222 include:

Beginning on January 1, 2026, the bill requires PBMs to reimburse rural independent pharmacies for prescription drugs at a rate that is equal to or greater than the national average drug acquisition cost plus a dispensing fee.
On January 1, 2027, and every subsequent year, a PBM must increase the dispensing fee by one percent to account for inflation.
When recouping more than $1,000 as a result of an audit conducted on a rural independent pharmacy, PBMs must notify the pharmacy of the recoupment and the right to appeal.
PBMs may not prohibit a rural independent pharmacy from using a private courier to deliver a prescription drug to a patient or require a rural independent pharmacy to obtain consent from the PBM to use a private courier.
The bill permits a prescription drug outlet that acts as a rural independent pharmacy to operate without the direct supervision of a pharmacist if the initial interpretation and final evaluation of the prescription are done by a pharmacist, either in person or remotely.

The bill defines a "rural independent pharmacy" as a privately owned prescription drug outlet with at least one licensed pharmacist as an owner and no ownership or affiliation with a chain pharmacy or a publicly traded entity.

For more information, please contact the PBM Enforcement Division at dora_pbm_compliance@state.co.us.

Regulation 4-2-104 Concerning Disclosures of Prescription Drug Contract Terms to Policyholders by Carriers and Pharmacy Benefit Managers

Guidance for Regulation 4-2-104

Contract Term Disclosures and Attestation Requirements

This update is intended to assist carriers and PBMs in preparing for compliance ahead of the first required filing and clarifies expectations around timing, plan year applicability, and filing structure.

What’s New:

Attestation Deadline Extended:
The first required attestation under Section 6 of the regulation is now due September 1, 2025. This is an extension of the originally anticipated timeline to provide carriers and PBMs more time to comply.

Plan Year Clarification:
The attestation and disclosure requirements apply to Plan Year 2025, covering the period from January 1, 2025, through December 31, 2025. The Division confirms that both the disclosure (Section 5) and attestation (Section 6) provisions are tied to this plan year.

Annual Attestation Schedule:
Beginning with the Plan Year starting in 2026, annual attestations will be due on June 1 of each year.

Separate Filings by Market Segment:
Each filing must meet the requirements of Regulation 4-2-104 for that specific segment.

Carrier Responsibility:
While carriers may allow PBMs to submit contract term disclosures on their behalf, carriers remain ultimately responsible for ensuring full compliance with all provisions of Regulation 4-2-104.

For more information, please contact the PBM Enforcement Division at dora_pbm_compliance@state.co.us.